Scarring and Breast Cancer

What Type of Scarring to Expect and How to Reduce It

The Washington Post. Credit: The Washington Post / Contributor / Getty Images

Breast cancer treatment almost invariably involves some type of surgery and scarring is an unavoidable part of the process. But that doesn't mean that disfigurement is inevitable.

Scars can range from small ones after a breast-conserving lumpectomy or big ones after a mastectomy procedure that removes the entire breast. Either way, most breast cancer patients are left with a surgical scar as a by-product of their quest to heal.

Radiation therapy can also leave lasting marks, ranging from a localized, temporary burn that resembles a sunburn to a hardened, stiff-type tissue known as radiation fibrosis.

Even chemotherapy, which is often delivered through an intravenous line or catheter, has the potential to leave some scarring since the catheters are inserted during minor surgical procedures that pierce the skin.

"I tell patients that none of us gets through life without emotional and physical scars and that all of us are going to end up being scarred," says Mary Jane Massie, MD, a psychiatrist specializing in breast cancer counseling at Memorial Sloan-Kettering Cancer Center in New York City. "Most people with cancer do a lot of thinking about that."

Factors That Affect Scarring in Breast Cancer Treatment

The amount and extent of scarring that results from breast cancer treatment depends on several factors, including the type of surgery performed and each patient's individual propensity to form scar tissue.

Even with nearly 60% of patients opting for lumpectomies, surgery that spares the breast but removes the cancerous tumor and some surrounding tissue, though, scarring can still cause problems.

Lumpectomies can range from the removal of a small piece of breast tissue for testing to having a full quarter of the breast taken — possibly resulting indenting or unevenness.

On the other hand, with a modified radical mastectomy or the surgical removal of the entire breast, which is chosen by 40% of patients, usually a long, slit-like scar is left that runs from the breastbone to the armpit area.

For both of these surgeries, breast reconstruction is an option, but one of the ways to achieve this actually results in at least one more scar. A flap of tissue can be taken from the women's abdomen or other area of the body, depending on the amount needed to restore the form of the breast, but this results in additional scarring at the site from where the tissue was harvested.

Breast Scars, Body Image, and Intimacy

"Some women choose mastectomy with reconstruction because they feel there will be a better cosmetic outcome," says Debbie Saslow, Ph.D., director of breast and gynecologic cancer at the American Cancer Society in Atlanta. "Some women have a really strong reaction to the scarring — it affects their body image and their sex lives – and other women can almost ignore it."

Karen Eggers, 38, at the time of her breast cancer diagnosis, wasn't able to ignore the scarring and change to her body shape, so she opted for reconstruction. "The long-term scars really have faded," says the Atlanta resident, now 45 and cancer-free. "But the reconstructed breast doesn't look quite the same."

Mastectomy patients who decide against breast reconstruction have to adjust not only to a changed body shape but also to the overt presence of scars that are not easily disguised when they disrobe.

"The issue that comes up all the time among patients is, "How do I explain my scars to people who will be seeing them?'," says Massie, who notes that this is mentioned most frequently by women who are between intimate relationships. These concerns, she adds, can be best addressed by getting input from counselors, plastic surgeons or fellow breast cancer patients.

Healing and Dealing With Scars

One of the best ways to limit scarring is by preventing infection immediately after surgery. Many patients are sent home from the hospital with drains attached to their incisions that remove excess blood and lymph fluid from the site. After these are taken off a few days later, patients need to keep the wound as clean as possible as it continues to heal and carefully follow doctor's orders regarding bandage changes.

Other scar-reducing techniques include lightly stretching and massaging the scar area daily during the first year when most healing occurs. Known by therapists as transverse friction massage, it involves gently manipulating the skin perpendicularly above and below the incision, from the collar bone to the bottom of the ribcage, and from the breastbone to under the armpits.

Since the implications of scarring aren't only cosmetic — pain and tightness can also result — professionals are sometimes needed to help ease the patient's scar tissue into a healthier healing pattern. Using vigorous, deep and soft-tissue massage, physical therapists may help relieve the pain and feelings of constriction.  New techniques are also being developed in using lasers, Botox and cytokines.

Alternative therapies can include yoga, which involves deep breathing and whole-body stretches, and also acupuncture, which uses thin needles inserted just below the skin in certain areas to relieve pain. One way to deal with a scar is to conceal it with a tattoo. That's an option gaining in popularity.

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Eggers, Karen. Atlanta, GA. Telephone interview, 2 Jul. 2008.

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Massie, M.D., Mary Jane. Psychiatrist, Memorial Sloan-Kettering Cancer Center, NYC. Telephone interview, 14 Jul. 2008.

Saslow, Ph.D., Debbie. Director of breast and gynecologic cancer, American Cancer Society, Atlanta, GA. Telephone interview, 3 Jul. 2008.

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